The city is routinely forcing paramedics and emergency medical technicians to work 16-hour shifts because of chronic staffing shortages that could be solved by changing shift lengths, a proposal which the medics' union has fought for at least two years, sources said.

Every day, as many as ten paramedics and EMTs are being forced to work back-to-back shifts of up to 16 hours on city ambulances, a situation that the man who oversees the service describes as "completely unacceptable."

Mark Rigg, director of the city's Emergency Services Department, said city EMS suffers from a 15 percent vacancy rate, with 30 paramedic and EMT posts unfilled out of 220 funded positions.

Rigg said he knows mandatory overtime is a bad situation for employees and the people they care for.

"They have to take care of patients. We have people calling for critical calls. They do dosage calculations. They drive emergency vehicles. It's important that they're rested, so we're working hard on that," Rigg told Hawaii News Now Monday.

Because of staffing shortages, some ambulance crew members are forced to work two or three 16-hour days in a row, leading some of them to call in sick just to get some rest. Sometimes, medics work 17 or 18 hours straight, if they get a call just before their second shift is finished or they have to finish paperwork on a late call, sources said.

And the overtime is adding up. For the past two years, the city spent about $5 million a year on OT for ambulance operations, EMS officials said. For the fiscal year that ends June 30, the city is on track to spend several hundred thousand dollars more in ambulance overtime than last year's $5 million figure, an EMS spokeswoman said.

So the city is negotiating to change ambulance crews' regular work shifts from eight hours to perhaps 12 hours, allowing more shifts to be covered with fewer employees, freeing up others to fill in for sick, vacationing or injured co-workers.

"So all of a sudden we have additional personnel to staff our units without having to make people stay," Rigg said.

But the state health director, whose department pays for ambulance service on Oahu that's run by the city, said the ambulance employees' union, the United Public Workers, initially balked at that proposal.

"The union had some ideas about other potential length of shift and ways to construct the shift and it just really hasn't made enough progress and hopefully it can still happen, because it's quite a crisis now," said Dr. Linda Rosen, who has been the state's chief of emergency medical services for years and took over as health director earlier this year after the death of then-Health Director Loretta Fuddy.

"I am hopeful that the increase in shift length could really buy them some time and then they can look at their training and retention and really build up to full staffing again," Rosen said.

Sources said UPW has not allowed the 12-hour shift proposal to advance for approximately two years, even though many of their employee members in the city ambulance service have asked for changes in shift lengths to ease the staff shortage.

A message left with UPW at its Kalihi offices Monday afternoon was not returned.

Another problem: city ambulance employees keep quitting for higher-paying jobs at county and federal fire departments, and the stressful atmosphere drives new recruits out.

"So we have this sort of vicious cycle of people coming and leaving so that they don't consistently have a full work force, and that causes this type of forced overtime," Rosen said.

Rigg said there is some initial relief on the way, with 14 new city EMTs scheduled to complete orientation in the next few weeks.

Kapiolani Community College has added a third EMT class this summer that will eventually help fill more ambulance vacancies, Rigg added.

But city paramedics said a handful of co-workers will be leaving in the coming months for higher-paid county firefighter jobs on Oahu and Hawaii Island. Others have left the city to become nurses, roughly doubling their pay after completing nursing coursework.

For the last three weekends, the city has hired private contractor American Medical Response for an additional ambulance rig and paramedics to handle calls in urban Honolulu from 11 p.m. Friday to 11 p.m. Sunday, to help with increased call weekend call volume. The AMR unit is directly tied in with city ambulance dispatchers so it can quickly respond to calls, Rigg said.

Rigg said the staffing shortage, that's been a problem for several years, got worse this past January, when the city sent 15 of its EMTs to paramedic school. The city requires EMTS to become paramedics, requiring extra training, after five years on the job.

An EMT is trained to offer basic life support and help paramedics in the field. A paramedic, officially known as a mobile intensive care technician or MICT, performs advanced life support and administers drugs to patients.

While EMTs take about six months to train, it can take three and a half years to train and fully prepare a paramedic, according to paramedics familiar with the training process. Starting EMTs are paid about $42,000 a year base pay, while beginning paramedics make roughly $54,000 a year without overtime.

In recent years, city EMS officials instituted one controversial measure to try to combat the staffing shortage: limiting the number of paramedics and EMTs who can take vacation to just ten people a day, reducing that number from a previous 13-people-a-day vacation limit. Ambulance employees said some co-workers use some their 21 sick days a year for vacation time that has been denied by managers because of the vacation limits.

The Pennsylvania Judicial Center serves as an administrative headquarters for Pennsylvania’s courts which are administered by the Supreme Court. (Source: Unified Judicial System of Pennsylvania)

Court records in a monthslong legal fight over the report say it identifies more than 300 "predator priests" and that grand jurors accuse church leaders of brushing aside victims to protect abusers and church institutions.

Court records in a monthslong legal fight over the report say it identifies more than 300 "predator priests" and that grand jurors accuse church leaders of brushing aside victims to protect abusers and church institutions.